PURPOSE: To understand the relationship between the gait patterns in transverse plane and the transverse plane deformities. MATERIALS AND METHODS: We evaluated the clinical, radiological, and three-dimensional gait analysis data of 152 spastic diplegics with transverse plane deformities. We define the transverse plane deformities as follows: 1) femoral anteversion > or =30 degrees, 2) thigh foot angle < or =-5 degrees or > or =25 degrees, 3) severe foot deformities that could affect the foot progression angle. RESULTS: We classified gait patterns of spastic diplegics into 6 groups on the base of pelvic compensation and foot progression angle, and divided anatomic characteristics into symmetric and asymmetric type. Among the gait patterns, pattern I-A (in-toeing with pelvic compensation) and II-A (in-toeing without pelvic compensation) were most prevalent. Femoral antetorsion was the most frequent torsional deformities, whereas valgus of foot was second most. CONCLUSION: We classified the gait patterns and analyzed the relationship between each gait pattern and types of torsional deformities.
Cerebral Palsy* ; Compensation and Redress ; Congenital Abnormalities* ; Foot ; Foot Deformities ; Gait* ; Muscle Spasticity* ; Thigh

PURPOSE: The authors evaluated the clinical and radiological short-term results of ceramic on ceramic articulation of cementless total hip arthroplasty. MATERIALS AND METHODS: One hundred fourteen patients, with a total of 130 hips were followed for more than 2 years after cementless total hip arthroplasty using ceramic on ceramic articulation (Lima. SPH-C2). The mean age was 58 years, and the mean follow-up period was 3.0 years. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using various radiological indices such as subsidence, cup inclination angle, radiolucent line, endosteal new bone formation and osteolysis. RESULTS: At last follow-up, the average Harris hip score improved from 57.5 points preoperatively to 93 points postoperatively. There were 4 cases (3.0%) of significant hip pain. Radiologically, all stems demonstrated stable fixation. The inclination of the acetabular cup was significantly changed in 4 cases (3%), and was diagnosed as loosened. A radiolucent line was observed around the stem in 5 cases (3.8%), and around the cup in 7 cases (5.4%). Endosteal new bone formation was observed around the stem in 47 cases (36.2%), and around the cup in 52 cases (40.0%). Osteolysis was not observed around the stem and the cup. CONCLUSION: With a minimum follow-up of 2 years, ceramic on ceramic articulation hip arthroplasty demonstrated excellent results on the stem side. However, 4 cases (3.0%) of cup loosening suggest that there is a fixation problem due to the design of the cup.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Ceramics* ; Follow-Up Studies ; Hip ; Humans ; Osteogenesis ; Osteolysis

PURPOSE: The purpose of this study was to evaluate the short term clinical results of the new anatomical reconstruction including 3 major posterolateral structures of the knee using a split Achilles allograft. MATERIALS AND METHODS: Eleven knees with posterolateral rotary instability underwent new anatomical posterolateral reconstruction between January 2002 and June 2003. The clinical results were assessed using the Lysholm score and Tegner activity level scales and physical examinations including posterolateral drawer test, dial tests at 30 and 90 degrees of knee flexion, varus stress tests at 0 and 30 degrees of knee flexion. RESULTS: Follow-up averaged 26 months (range, 12 to 29 months). The mean preoperative Lysholm score was 38.6 and at the time of latest follow-up, the mean score was improved to 72.5. The mean preoperative Tegner activity level was improved from 1.6 points to 3.3. Ten out of 11 patients showed negative conversion of the posterolateral drawer test and varus stress test at 30 degrees of flexion postoperatively. All patients, who showed positive signs on the external rotation-dial test at 30 degrees of knee flexion preoperatively, improved postoperatively. In eight patients, preoperative positive signs of varus stress tests at 0 degrees of knee flexion and the external rotation-dial test at 90 degrees of knee flexion disappeared postoperatively. CONCLUSION: This study suggests that the new anatomical reconstruction of posterolateral corner of knee is a reliable method providing excellent stability and satisfactory short term clinical results.
Achilles Tendon* ; Allografts* ; Exercise Test ; Follow-Up Studies ; Humans ; Knee* ; Physical Examination ; Weights and Measures

PURPOSE: To investigate the effect of lateral buttress on the fracture healing of Jensen type 4 intertrochanteric fracture of the femur treated by dynamic compression hip screw (DCS) in elderly patients, retrospectively. MATERIALS AND METHODS: From March 1999 to February 2003, 54 patients, older than 65 years, of Jensen type 4 intertrochanteric fractures of the femur treated by DCS were included. The relationship between the structual integrity of lateral buttress measured by proximal-medial fragment angle (PMFA) and postoperative neck-shaft angle, penetrating length of lag screw, the sliding length and incidence of fixation loss were evaluated. RESULTS: Among 38 patients of group II (PMFA above 50 degree), 6 cases (15.8%) including 4 cases of cutting out of lag screw from femoral head, 1 case of nonunion and 1 case of excessive extrusion of lag screw failed radiologically. But there was no fixation loss case in 16 cases of group I (PMFA 50 and below 50). The neck-shaft angle in last follow-up was 138.1 degree in group I and 132.1 in group II. The sliding length of lag screw was 7.0 mm in group I and 12. 5 mm in group II (p<0.05). CONCLUSION: Preoperative evaluation of intactness of lateral buttress measured by proximal-medial fragmentary angle is an useful method in treatment of Jensen type 4 intertrochanteric fractures treated by DCS in elderly patients.
Aged* ; Femur* ; Follow-Up Studies ; Fracture Healing ; Head ; Hip Fractures* ; Hip* ; Humans ; Incidence ; Retrospective Studies

PURPOSE: To evaluate the efficacy and the result of the ilioinguinal approach in the operative treatment of acetabular fractures. MATERIALS AND METHODS: A retrospective analysis was performed on 22 patients who were available for follow-up over one year. The reduction quality, clinical results, and radiographic results were analyzed based on the criteria of Matta. Complications were recorded as well. RESULTS: Anatomical reduction (0-1 mm displacement) was achieved in 18 cases (81.9%) and imperfect reduction (2-3 mm displacement) was achieved in 4 cases (18.1%). Excellent clinical and radiographic results were graded in all of the 18 anatomically reduced fractures. The clinical results were excellent in 1 case, good in 2, and poor in 1; although radiographic results were good in 4 cases with imperfect reductions. Complications included 5 cases with a transient lateral femoral cutaneous nerve injury, which resolved during the follow-up period and 1 case with a partial femoral nerve palsy. CONCLUSION: The ilioinguinal approach is effective for anterior wall, anterior column, and associated anterior and posterior hemitransverse fractures; as well as both column, transverse fracture, and T-shaped fractures. The risk of iatrogenic lateral femoral cutaneous nerve damage is relatively high, but there were no residual symptoms at the time of latest follow-up evaluation.
Acetabulum* ; Femoral Nerve ; Follow-Up Studies ; Hip Joint ; Humans ; Paralysis ; Retrospective Studies

PURPOSE: To compare the results associated with the standard medial parapatellar approach and the midvastus approach in primary total knee arthroplasty. MATERIALS AND METHODS: A total of 70 cases who underwent total knee arthroplasty were evaluated. All patients have varus deformity in standing AP view, but subluxation of the patella on the Merchant view was excluded. Medial parapatellar approach (35 cases) and midvastus approach (35 cases) were used. The operation time, blood loss, incidence of lateral release, time to perform straight leg raising, time to get 90 degrees flexion, range of motion, VAS, Knee Society Knee Scores, tibio-femoral angle and patella tilt were compared. The results were analyzed using the student's t-test. RESULTS: No significant difference was noted between medial parapatellar and midvastus approach regarding to the operation time, blood loss, range of motion, VAS and Knee Society Knee Scores (p>0.05). However, midvastus approach provide two significant advantages of the incidence of lateral release (40% vs 6%) and the time to perform straight leg raising (4.5 days vs 1.9 days) (p<0.05). CONCLUSION: Midvastus approach is an efficacious alternative to the medial parapatellar approach in terms of the excellent exposure and reducing the incidence of lateral retinacular release.
Arthroplasty* ; Congenital Abnormalities ; Humans ; Incidence ; Knee* ; Leg ; Patella ; Range of Motion, Articular

PURPOSE: The purpose of this study is to provide the clinical results of arthroscopic posterior cruciate ligament (PCL) reconstruction with preservation of the original ligament with use of a posterior trans-septal portal and to compare the clinical outcomes between double-loop hamstring tendon autografts and Achilles tendon allografts. MATERIALS AND METHODS: 36 patients underwent PCL reconstruction with hamstring tendon autografts and with Achilles tendon allografts. At the final follow-up, patients were evaluated by four measurements: Lysholm knee scores, Telos stress radiography, IKDC grade, and second look arthroscopic examination. RESULTS: The postoperative mean Lysholm knee scores, the postoperative mean distances of posterior displacement by the Telos stress test, and the postoperative IKDC grades demonstrated statistically significant differences compared to the preoperative. The postoperative mean distances of posterior displacement by the Telos stress test and the postoperative IKDC grades demonstrated no statistically significant difference between two groups. CONCLUSION: The clinical results of arthroscopic PCL reconstruction with preservation of the original remnant ligament with use of a posterior trans-septal portal were good. The clinical outcomes of double-loop hamstring tendon autografts were equivalent to those of the Achilles tendon allograft.
Achilles Tendon ; Allografts ; Autografts ; Exercise Test ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Posterior Cruciate Ligament* ; Radiography ; Tendons

PURPOSE: We evaluated the relationship among the various rotational reference axes of femoral component in TKA, and the potential change in rotational alignment when a posterior condylar axis (PCA) was used as a reference for different cartilage erosions between the medial and lateral posterior femoral condyles. MATERIALS AND METHODS: The study subjects included twenty male and twenty female volunteers. Axial MR image of the distal femur were used to measure the angles among the clinical transepicondylar axis (cTEA), surgical transepicondylar axis (sTEA), the PCA, and the AP axis. We then evaluated the difference in the amount of rotation between a normal and osteoarthritic model when the PCA was used as a rotational reference. RESULTS: The mean angle between cTEA and PCA was 5.4 degrees, and it was significantly greater in the female (6.5 degrees) than in the male group (4.3 degrees). The cTEA demonstrated a perpendicular relationship with the AP axis in both groups. The average angles between cTEA and sTEA were 3.2 degrees in the male group and 3.8 degrees in the female group. When we assumed complete erosion of the cartilage on the medial posterior condyle with preservation on the lateral side, the angles between the cTEA and PCA decreased by an average of 1.9 degrees in both groups. CONCLUSION: This study suggests that the two transepicondylar axes, which demonstrated greater than 3 degrees in angle-difference, should be defined clearly in scientific reports and in their application as rotational references in TKA. Some significant gender differences in the rotational profile were noted. When the PCA is used as a rotational reference, potential errors caused by the different amounts of cartilage erosion between the medial and lateral posterior condyles should be considered.
Axis, Cervical Vertebra ; Cartilage ; Female ; Femur* ; Humans ; Male ; Passive Cutaneous Anaphylaxis ; Volunteers

Satisfactory results of unicondylar knee arthroplasty (UKA) have been reported since minimally invasive UKA had been introduced. However, several stress fractures of the tibial plateau, related to instrumentation design, have been reported. We report two cases of periprosthetic stress fractures of the tibial plateau after navigation-assisted unicondylar knee arthroplasties.
Arthroplasty* ; Fractures, Stress* ; Knee*

PURPOSE: To evaluate the clinical results of arthroscopic debridement in osteoarthritic ankle and prognostic factors. MATERIALS AND METHODS: Between Feb. 2001 and Mar. 2004, twenty-seven patients who had an osteoarthritic ankle disease were managed by arthroscopic debridement. The mean age of the patients was 50.0 years (20-71) and the mean follow-up after operation was 16.2 months (12-36). There were 18 men (66.7%) and 9 women (33.3%). The preoperative radiographic findings were divided into 4 groups according to the classification system by Takakura et al. Preoperative AOFAS ankle-hindfoot scale and subjective satisfaction were checked at the last follow-up visit, and the results were compared. RESULTS: In radiological evaluation, stage I was 6 cases (22.2%), stage II was 14 cases (51.9%), stage III was 4 cases (14.8%), and stage IV was 3 cases (11.1%). The mean preoperative AOFAS ankle-hindfoot scale was 59.1+/-16.7 and improved to 66.5+/-24.3 at last follow-up. Especially, in stage I, preoperative AOFAS score was 69.3+/-18.7 and improved to 74.3+/-29.7, and in stage II, preoperative AOFAS socre was 63.0+/-9.6 and improved to 77.1+/-12.9. But in the stage III and IV, preoperative scores were not improved. The preoperative radiographic findings correlated with the outcome at the last follow-up time (p<0.05). The group with loose body and the group without anterior osteophyte showed better AOFAS score compared to the control group, but there was no statistically significant difference between the two-groups. In subjective satisfaction, excellent or good results were achieved in 14 cases (51%). CONCLUSION: We suggest that arthroscopic debridement is an effective treatment in which preservation of alignment and reasonable articular cartilage can be achieved.
Ankle* ; Cartilage, Articular ; Classification ; Debridement* ; Female ; Follow-Up Studies ; Humans ; Male ; Osteoarthritis ; Osteophyte